Provider Demographics
NPI:1962745877
Name:WEIGEL, EMILIE BUNDERSON (MD)
Entity type:Individual
Prefix:MRS
First Name:EMILIE
Middle Name:BUNDERSON
Last Name:WEIGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11724 NE 195TH STREET
Mailing Address - Street 2:SUITE #100
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11724 NE 195TH STREET
Practice Address - Street 2:SUITE #100
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011
Practice Address - Country:US
Practice Address - Phone:425-318-3100
Practice Address - Fax:425-318-3101
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML60369024208000000X
390200000X
WAMD60644672208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program